Zhao Hong, Shi Yu, Dong Huihui, Hu Jianhua, Zhang Xuan, Yang Meifang, Fan Jun, Ma Weihang, Sheng Jifang, Li Lanjuan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Am J Med Sci. 2018 Feb;355(2):132-139. doi: 10.1016/j.amjms.2017.08.003. Epub 2017 Aug 3.
The aim of the present study was to determine the specific role of different types of bacterial infections (BIs) on the prognosis of cirrhotic patients with acute decompensation (AD).
We performed a prospective, observational cohort study consisting of 492 cirrhotic patients with AD at our center from February 2014 to March 2015. Clinical, laboratory and survival data were collected. The relationship between BIs and mortality was analyzed.
BIs were identified in 157 of 492 patients at the time of admission or during the hospital stay. Among the patients, 65 had community-acquired (CA) or healthcare-associated (HCA) BIs, 54 developed hospital-acquired (HA) BIs, and 38 had CA/HCA with HA BIs. Patients with CA/HCA BIs had higher 90-day, 1-year and 2-year mortality rates (29.2%, 44.6% and 52.3%, respectively) and CA/HCA BIs remained an independent risk factor for long-term mortality on multivariate analysis (1 year: hazard ratio = 1.60; 95% CI: 1.07-2.41; P = 0.023 and 2 year: hazard ratio = 1.54; 95% CI: 1.05-2.25; P = 0.026). In contrast, patients with HA BIs had a higher 28-day mortality rate than patients with CA/HCA BIs. Logistic regression analysis showed previous ascites and prior BIs within 3 months were independent risk factors for CA/HCA BIs, whereas invasive minor surgical procedures with acute-on-chronic liver failure throughout the hospital stay and high chronic liver failure-sequential organ failure assessment scores were associated with nosocomial BIs.
CA/HCA BIs were associated with increased long-term mortality in cirrhotic patients with AD, whereas nosocomial BIs may be related to poor short-term prognosis.
本研究的目的是确定不同类型的细菌感染（BI）对急性失代偿期（AD）肝硬化患者预后的具体作用。
我们进行了一项前瞻性观察队列研究，纳入了2014年2月至2015年3月在我们中心就诊的492例AD肝硬化患者。收集了临床、实验室和生存数据。分析了BI与死亡率之间的关系。
492例患者中，157例在入院时或住院期间被确诊为BI。其中，65例为社区获得性（CA）或医疗保健相关（HCA）BI，54例发生医院获得性（HA）BI，38例既有CA/HCA BI又有HA BI。CA/HCA BI患者的90天、1年和2年死亡率较高（分别为29.2%、44.6%和52.3%），多因素分析显示CA/HCA BI仍然是长期死亡率的独立危险因素（1年：风险比=1.60；95%可信区间：1.07-2.41；P=0.023；2年：风险比=1.54；95%可信区间：1.05-2.25；P=0.026）。相比之下，HA BI患者的28天死亡率高于CA/HCA BI患者。逻辑回归分析显示，既往腹水和3个月内的既往BI是CA/HCA BI的独立危险因素，而住院期间的侵入性小手术合并慢加急性肝衰竭以及高慢性肝衰竭-序贯器官衰竭评估评分与医院获得性BI相关。
CA/HCA BI与AD肝硬化患者的长期死亡率增加相关，而医院获得性BI可能与短期预后不良有关。
